Auto-downcoding could mean practices will 'lose revenue, cut provider pay and struggle to make do with less'

by: Julia Kyles, CPC Jun 22, 2022

Coding professionals agree: It is easier to meet the requirements for a level 4 E/M office visit under the revised guidelines for office or other outpatient visits (PBN 6/13/22, subscription required). Unfortunately, there are internal and external obstacles to receiving payment for high-level visits according to the handout for the June 29 webinar Boost Your E/M Revenue: Document and Code High-Level Visits with Confidence.

The upcoming webinar will be presented by Nancy Enos, FACMPE, CPC-I, CPMA, CEMC, CPC Emeritus.

According to Enos’ handout, practices that aren’t comfortable with the guidelines may downcode their claims because they mistakenly believe it will protect them from audits. In addition, some private payers may automatically downcode high level claims.

"As a result, practices lose revenue, cut provider pay, and struggle to make do with less at a time when practices and employees are trying to recover from the shocks of 2020," Enos wrote in her presentation.

Practices can appeal downcoding and denials, but their claims must be based on a solid understanding of the guidelines and documentation that supports the selected level whether the practice coded the encounter based on medical decision-making or time. The webinar will include guidance for making sure claims will stand up to downcoding and denials such as the summaries on slides 57 and 58.

Enos will supply detailed guidance and answer attendee questions on June 29, 1-2 p.m., ET. The 60-minute webinar has been approved for 1 AAPC CEU and 1 BMSC CEU.

Blog Tags: claims processing, E/M services

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